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The Democratic Strategist

Political Strategy for a Permanent Democratic Majority

State-Based Health Reform and 2010

This item by Ed Kilgore was first published on October 8, 2009.
The last staff post on public option alternatives percolating in the Senate really got me thinking: are the senators or health reform advocates kicking around state-based approaches to the public option really thinking through the political implications of taking this route? Or are they just focused on their own legislative problems?
The one thing that’s clear about these approaches is that they would considerably ramp up the importance of health reform in state politics going into an already crazy 2010 election cycle. I’ve got a post up at The New Republic raising this issue, and wondering if state politicians in either party are quite ready for this challenge. In effect, letting the states make the most fundamental decisions about how to design a health care system–not just for the Medicaid or SCHIP participants they currently deal with, but for pretty much everybody–would simply shift all the many controversies we’ve seen in Congress this year to state capitals.
It’s hard to say how this would all play out. Chris Bowers suspects Republican-controlled states (including some where a public option is most needed) would kill any sort of public option immediately. Others may be more sanguine given the general popularity of the public option nationally. All I’m saying is that senators and health reform advocates need to think and talk about this political reality at some depth, and not simply seize on state-based approaches as a clever way out of their own dilemmas.
It’s reassuring that one of the proponents of a state-based approach, Tom Carper, is a former Governor, who presumably understands the political implications at the state level. And it’s encouraging that two others, Maria Cantwell and Ron Wyden, are trying to enable the states to adopt reforms more radical than any we would see in a one-size-fits-all national reform template. But a 2010 state political cycle dominated by a raucous health care debate is a tricky proposition, particularly given the potential impact of health industry dollars on legislators and candidates alike.
Look before you leap, senators.

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